Abstract：
Vestibular-evoked myogenic potentials (VEMPs) can help assess otolithic neural pathway in the brainstem that may also participate in cardiovascular autonomic function. Parkinson\'s disease (PD) is associated with altered VEMP responses; however, the association between VEMP abnormalities and multiple system atrophy (MSA) remains unknown. Therefore, we compared the extent of otolith dysfunction using ocular (oVEMP) and cervical VEMP (cVEMP) between MSA and PD. We analyzed the clinical features and VEMP and head-up tilt table test (HUT) findings using the Finometer in 24 patients with MSA and 52 with de-novo PD, who had undergone neurotologic evaluation in a referral-based university hospital in South Korea from January 2021 to March 2023. MSA was associated with bilateral oVEMP abnormality (odds ratio [95% confidence interval] = 9.19 [1.77-47.76], p=0.008). n1-p1 amplitude was negatively correlated with Unified Multiple System Atrophy Rating Scale I-II scores in patients with MSA (r=-0.571, p=0.033), whereas it did not correlate with Movement Disorder Society-Unified Parkinson\'s Disease Rating Scale-III scores in patients with PD (r=-0.051, p=0.687). n1 latency was negatively correlated with maximum changes in systolic blood pressure within 15 s during HUT in patients with PD (r=-0.335, p=0.040) but not in those with MSA (r=0.277, p=0.299). In conclusion, bilaterally abnormal oVEMP responses may indicate the extent of brainstem dysfunction in MSA. oVEMP reflects the integrity of otolith-autonomic interplay, reliably assists in differentiating between MSA and PD, and helps infer clinical decline.
摘要：
前庭诱发的肌源性电位（VEMPs）可以帮助评估脑干中的耳石神经通路，该通路也可能参与心血管自主神经功能。帕金森病（PD）与VEMP反应改变有关；然而，VEMP异常与多系统萎缩(MSA)之间的关联尚不清楚.因此,我们比较了MSA和PD之间使用眼（oVEMP）和宫颈VEMP（cVEMP）的耳石功能障碍程度。我们使用Finometer分析了24例MSA患者和52例新生PD患者的临床特征以及VEMP和抬头倾斜台测试（HUT）结果，从2021年1月至2023年3月，他在韩国一家转诊的大学医院接受了神经学评估。MSA与双侧oVEMP异常相关(比值比[95%置信区间]=9.19[1.77-47.76],p=0.008)。n1-p1波幅与MSA患者多系统萎缩统一评定量表I-II评分呈负相关(r=-0.571,p=0.033),而它与PD患者的运动障碍社会-统一帕金森病评定量表-III评分无关（r=-0.051，p=0.687）。PD患者的n1潜伏期与HUT期间15s内收缩压的最大变化呈负相关（r=-0.335，p=0.040），而MSA患者则不相关（r=0.277，p=0.299）。总之,双侧异常oVEMP反应可能表明MSA脑干功能障碍的程度。OVEMP反映了耳石-自主神经相互作用的完整性，可靠地帮助区分MSA和PD，并有助于推断临床下降。
